OP0128 ADHERENCE TO MEDICATIONS DURING PREGNANCY IN SYSTEMIC AUTOIMMUNE DISEASE
Authors: D. Zucchi, F. Racca, C. Tani, E. Elefante, C. Stagnaro, L. Carli, V. Signorini, F. Ferro, F. Trentin, S. Gori, M. Mosca
Journal: Annals of the Rheumatic Diseases (2022)

Background Low medication adherence is a well known issue in the management of patients with systemic autoimmune diseases (SAD), little however is known on adherence to medication during pregnancy, especially in these patients with high risk pregnancies. Objectives This study is aimed at evaluating the level of adherence to medication in pregnant patients with SAD in comparison with non-pregnant patients with SAD, and at identifying determinants of low adherence. Methods Pregnant and non-pregnant patients with an established diagnosis of SAD were consecutively enrolled. Pregnant patients were included in a tight monitoring protocol for high risk pregnancies, and treatments were checked every month. The following data were collected at enrolment: epidemiological and demographic characteristics, disease duration and type of medications. Each patient completed the following anonymous questionnaires: the 8-item Morisky Medication Adherence Scale (MMAS-8) and Hospital Anxiety and Depression Scale (HADS) to assess the presence of anxiety and depression. With regard to MMAS-8, we assessed adherence to hydroxychloroquine (HCQ) and to other disease modifying antirheumatic drugs (DMARDs) separately. We considered a score ≥ 6 as indicator of good adherence. Vitamins and dietary supplements were not considered. Results A total of 80 pregnant women and 72 non-pregnant women were enrolled. Clinical data and results of the questionnaires are summarized in Table 1. Table 1. Characteristics of the cohort Pregnant patients N=80 Non-pregnant patients N=72 P value Age at study entry (years, mean ±SD) 35.8±4.3 40.1±12.2 0.001 Disease duration (years, mean ±SD) 8.5±6.6 8.6±9.1 n.s Number of tablets/day (mean ±SD) 4.3±1.6 4.1±1.8 n.s Number of assumption/day (mean ±SD) 1.4±0.6 1.6±0.8 n.s Score MMAS for HCQ (mean ±SD) 6.99±0.2 6.38±0.2 0.039 Score MMAS for other DMARDs (mean ±SD) 6.99±0.3 6.39±0.2 0.018 Patients with good adherence to HCQ (%) 38/50 (76.0%) 34/59 (57.6%) 0.044 Patients with good adherence to medications (%) 53/71 (74.6%) 37/60 (61.7%) n.s Patients with low adherence to HCQ (%) 12/50 (24%) 25/59 (42.4%) 0.044 Patients with low adherence to medications (%) 18/71 (25.4%) 23/60 (38.3%) n.s Anxiety (%) 20 (25%) 30 (41.7%) 0.029 Depression (%) 11 (13.7%) 19 (26.4%) 0.051 MMAS-8 score was significantly higher in pregnant women both for HCQ (p=0.039) and other DMARDs (p=0.018), as well as the rate of patients with good medication adherence for HCQ (76.0% vs 57.6%, p=0.044). The rate of patients with good medication adherence for other DMARDs was higher in pregnant patients (74.6% vs 61.7%) but this different was not statistically different. Demographic and clinical characteristics and the number of therapies received didn’t seem to influence treatment adherence. Fifty patients (32.8%) suffered from anxiety, and this disorder was a significant determinant of low medication adherence in all groups. Conversely, depression didn’t seem to have an impact on adherence on neither group. Conclusion Overall, pregnant patients with SAD had a good adherence to prescribed medication; nevertheless, 25% of patients didn’t take therapies adequately despite being closely monitored in a dedicated clinic for high risk pregnancies and an adequate pregnancy counselling; anxiety seems to be one determinant of low medications adherence both in pregnant and non-pregnant women. Disclosure of Interests None declared